CAJ | 학술논문

目的　探讨在重型肝炎中，乙型肝炎病毒(HBV)前C区1896位基因突变与机体免疫水平的关系。方法　采用限制性酶切片段长度多态性分析(RFLP)检测HBV基因组前C区1896位是否存在变异，以单克隆抗体APAAP法比较末梢血T细胞亚群的分布情况，用双抗体夹心ELISA法检测血清细胞因子(TNF-a、IFN-γ、IL-6、IL-8)水平。结果　23例重型肝炎中，HBV基因变异株感染率为52 2%，而22例急性乙型肝炎中仅1例为变异株感染；变异株组CD8+T细胞百分率明显下降，CD4+/CD8+比值明显增高，CD3+、CD4+T细胞的百分率未见明显变化；重型肝炎中细胞因子(TNF-a、IFN-γ、IL-6、IL-8)水平均明显高于急性乙型肝炎相应之细胞因子水平，而变异株组IFN-γ、IL-6水平明显高于非变异株组，TNF-a和IL-8在两组间无明显差异；变异株组病死率(100%)明显高于野毒株组的病死率(9%)。结论　重型肝炎中，变异株HBV感染率很高；基因变异的HBV可能通过各种途径刺激机体的免疫系统，使免疫细胞活化，从而释放大量细胞因子，导致肝细胞损伤，甚至肝衰竭。
목적　탐토재중형간염중，을형간염병독(HBV)전C구1896위기인돌변여궤체면역수평적관계。방법　채용한제성매절편단장도다태성분석(RFLP)검측HBV기인조전C구1896위시부존재변이，이단극륭항체APAAP법비교말소혈T세포아군적분포정황，용쌍항체협심ELISA법검측혈청세포인자(TNF-a、IFN-γ、IL-6、IL-8)수평。결과　23례중형간염중，HBV기인변이주감염솔위52 2%，이22례급성을형간염중부1례위변이주감염；변이주조CD8+T세포백분솔명현하강，CD4+/CD8+비치명현증고，CD3+、CD4+T세포적백분솔미견명현변화；중형간염중세포인자(TNF-a、IFN-γ、IL-6、IL-8)수평균명현고우급성을형간염상응지세포인자수평，이변이주조IFN-γ、IL-6수평명현고우비변이주조，TNF-a화IL-8재량조간무명현차이；변이주조병사솔(100%)명현고우야독주조적병사솔(9%)。결론　중형간염중，변이주HBV감염솔흔고；기인변이적HBV가능통과각충도경자격궤체적면역계통，사면역세포활화，종이석방대량세포인자，도치간세포손상，심지간쇠갈。
Objective To study the relationship between the HBV precore 1896 site mutation and the host immunity. Methods HBV precore 1896 site mutation was confirmed by restriction fragment length polymorphism analysis; The cytokines (TNF-a、 IFN-γ、 IL-6 and IL-8) levels were measured by enzyme linked immunosorbent assay(ELISA) and T subpopulations by APAAP. Results In fulminant hepatitis, the infective rate of HBV mutate-type was 52.5 %, while only one patient was infected by mutate-type virus in acute hepatitis; The percentage of CD8 +T lymphocyte was obviously lower and the ratio of CD4+/CD8+ was obviously higher in mutate group than wild strain group; The cytokine levels in the patients with fulminant hepatitis were higher than those in acute hepatitis. The mortality of patients with mutate-type was higher ( 100 % ) than that of wild-type (9 % ). Conclusion In fulminant hepatitis, the infective rate of HBV mutate-type is high. The mutate-type virus provokes host immune system resulting in the activation of lymphocyte and release of cytokines, which contributed to severe liver damage.